Whole person, in person: 6 keys to a successful population health venture 

Benevera Health is just over two years old, but the Bedford, N.H.-based company may have cracked the code on how to successfully manage population health. 

Benevera is a joint venture between one payer — Harvard Pilgrim — and four health systems in New Hamsphire: Lebanon-based Dartmouth-Hitchcock, Manchester-based Elliot Health System, Rochester-based Frisbie Memorial Hospital and Nashua-based St. Joseph Hospital. 

"We bring those four providers together with Harvard Pilgrim to align all the goals and incentives. Everybody is marching in the same direction, with the same end point in mind," Janice Baker, Benevera's vice president of strategy and operations, said May 11 at the Becker's Hospital Review Health IT + Clinical Leadership meeting in Chicago. 

Together, the five entities have their sights set on growing Harvard Pilgrim membership in New Hampshire and steering those members to the hospital partners, while providing high-quality care, efficiently, at a lower cost. 

So far, it's working. Costs dropped 30 percent within 12 months after Benevera engaged with patients, while patient surveys and net promoter scores have indicated patients are highly satisfied, according to Ms. Baker. "What we've quickly realized is we've got something pretty cool here, and we think we can expand this and extend this to other entities in New Hampshire, or commodify it and bring it to other health systems," she said. 

Here are six things to know about what makes Benevera Health so successful.

1. The structure of the joint venture gives the partners space to discuss and test innovative payment and care ideas. The joint venture is captitated, structured so health system owners have full upside and downside risk for patients attributed to them. Harvard Pilgrim has shared financial accountability for all its members in New Hampshire. "Everybody has a seat at the table. It's collaborative and allows for open, interesting discussion," Ms. Baker said. "I've always told [the partners] this is a safe place to experiment, a safe placed to pilot, to do interesting and innovative things," she said. For example, they've discussed ideas such as a $0 primary care plan, where patients don't have to pay a copay if they see a partner provider, or giving patients a prompt-pay discount if they are Harvard-Pilgrim insured. 

2. Benevera Health focuses in on a specific population. "We are not for everybody," Ms. Baker said. "We really focus on folks who have emerging needs and high-needs." Benevera uses analytics from Optum to identify high-need patients and determine how to reach them. "We are very strategic about how we try to reach out to people," Ms. Baker said. It can be especially difficult to reach and engage patients with significant healthcare needs, making this strategy even more critical. 

3. However, Benevera casts a net wider than its partner providers' existing patient populations. Not all the patients are attributed to the four partner providers — in fact, most are not. Benevera Health has roughly 110,000 covered lives and only about one-third of that population is attributed to the four provider partners. The other two-thirds are attributed to other health systems throughout New Hampshire. While at first this seems counterintuitive, it allows the organization to get a broader picture of where patients are going for their care. "By bringing that data together, not just EMRs, but … claims data and all of the different places the patient is getting care, we get the full picture," Ms. Baker said. 

4. Benevera works to simplify the patient experience, and its solution is fairly low-tech. It starts with patient engagement specialists, who are hired entirely based on customer service skills. They are not nurses or social workers, but rather friendly, engaging people who do the initial patient outreach. Once the patient is engaged, the patient engagement specialist determines who the patient needs to see most. It may be a nurse, a social worker or a pharmacist. "Then that person owns the patient and is the single point of contact throughout the entire relationship," Ms. Baker said. 

5. Face time matters. Benevera puts significant time and effort into meeting with patients in person. That may mean meeting with a patient during their lunch hour at a local library or conferencing with them when they pick up their prescriptions at the pharmacy. To help facilitate these visits, Benevera has staff located throughout the state, living where most of their patient population is located. In addition to geographic proximity, this enables Benevera staff to know the communities where the patients live. 

For example, one patient's wife was growing increasingly anxious because the leaves in their yard were piling up. Her husband had always taken care of the lawn. As his primary caretaker, Benevera wanted to keep the patient's wife on an even keel. Local Benevera staff was able to call the community high school and find a student who needed service hours to rake the leaves. "Health systems know about barriers to care. A lot of them recognize them, note them and move on," Ms. Baker said. "We look at those and say we are going after them."

6. Whole person, whole family. Addressing the needs of the whole person — their clinical, financial, transportation, spiritual and mental health — is key to making a population health initiative work. But Benevera has realized the focus must also extend to the whole family. As illustrated with the previous example, Benevera understands how important it is to not only connect with the patient, but also their family and primary caretakers because patient outcomes are directly related to the ability, both mentally and physically, of their caretakers. The feedback has been largely positive. Ms. Baker said, "A lot of what folks say is, 'They listened to me. They cared about me. They helped me deal with the other barriers in my life.'" 


More articles on population health: 

Kaiser Permanente to support CityHealth population health initiative
Kaiser to invest $200M in community efforts to reduce homelessness
STDs on the rise among seniors

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